Indications and results of hepaticojejunostomy in benign strictures of the biliary tract.

The postoperative and late results of 99 patients with benign strictures of the biliary tract are presented. Patients were classified according to Bismuth into 24 cases with lesion type I, 36 cases with type II, 35 cases with type III and 4 patients with type IV. All were submitted to hepaticojejunostomy with a long Roux-en-Y loop. The etiology of the strictures varied according to the type of stricture. In patients of type I, inflammatory and iatrogenic causes were observed. Among type II and III patients, previous cholecytocholedochal fistulas were the main cause, together with accidental section or ligature of the common bile duct. Operative mortality was absent in strictures of types I and II, while it was around 25% in cases of types III and IV. At late control, the best results were seen among patients with strictures of types I and II. We believe that the main factor determining the early and late outcome of these cases with benign strictures is the location of the stricture and the quality of the proximal duct.

[A cooperative study on early and intermediate gastric cancer: clinical, diagnostic and therapeutic aspects]. / Estudio cooperativo en cancer gastrico incipiente e intermedio: aspectos clinicos, diagnosticos y terapeuticos.

A cooperative study involving 13 hospitals in Chile allowed the analysis of 353 patients with gastric cancer in early stages. 82 cancers were located at the mucosal level, 151 at the submucosa and 120 reached the muscular layer. There were no differences in age and sex among these groups. Compared to early stage, patients with intermediate stage had a greater incidence of bleeding, anemia and undernutrition and exhibited lower body weight. Endoscopy had a higher diagnostic yield compared to radiological study. The diagnosis was confirmed by biopsy in 95% of patients. Total or subtotal gastrectomy was performed according to the location of the lesion, with a low operative mortality rate. Early gastric cancer accounts for 8 to 10% of all patients with gastric cancer undergoing surgical treatment.

[Early complications of caustic injuries of the digestive tract]. / Complicaciones precoces de las lesiones por caustico del tubo digestivo.

We retrospectively analyzed the gastrointestinal complications observed in 119 patients who had ingested corrosive agents. Hydrochloric acid and sodium hydroxide were the agents involved in 62% of patients. Women predominated over men (p less than 0.001); mean age was 36 for males and 29 for women (p less than 0.05). Endoscopy was performed in 55% of patients and revealed acute lesions in 69%. Complications were observed in 18% of patients requiring surgery in 12 (10%). Main complications included sepsis of abdominal or mediastinal origin and gastrointestinal bleeding. Mortality among these patients was 73%.